Jinnah Hospital, Lahore

Background: Postoperative pain control is essential for early recovery, patient comfort, and reduced opioid requirement after modified radical mastectomy with immediate breast reconstruction. Objective: To compare thoracic paravertebral block and pectoral nerve block in terms of postoperative pain scores, nalbuphine requirement, time to rescue analgesia, and complications after modified radical mastectomy surgery. Materials and Methods: This randomized controlled trial was conducted in the Department of Anesthesia, Jinnah Hospital, Lahore from April 2022 to November 2022. A total of 54 patients undergoing modified radical mastectomy were included after informed consent and randomly allocated into two equal groups. Group A received thoracic paravertebral block, while Group B received pectoral nerve block. General anesthesia was induced using nalbuphine 0.1 mg/kg, propofol 2 mg/kg, and atracurium 0.5 mg/kg in all patients. Results: At rest in the post-anesthesia care unit, the mean NRS score was 1.44 f 0.51 in the paravertebral block group and 1.48 f 0.51 in the pectoral nerve block group (p=0.790). At 8 hours, the mean resting NRS score was significantly higher in the paravertebral block group compared with the pectoral nerve block group (4.15 f 0.60 vs 3.48 f 0.58; p<0.001). On movement in the post-anesthesia care unit, the mean NRS score was 2.67 f 0.48 in the paravertebral block group and 2.41 f 0.50 in the pectoral nerve block group (p=0.058). At 8 hours, movement-related pain was significantly higher in the paravertebral block group than in the pectoral nerve block group (4.52 f 0.70 vs 3.70 f 0.67; p<0.001). Conclusion: Pectoral nerve block provided better postoperative analgesia, lower pain scores at 8 hours, and longer duration before rescue analgesia compared with thoracic paravertebral block after modified radical mastectomy surgery. Both techniques were safe, with no observed complications.

INTRODUCTION:Patients presenting with acute coronary syndrome (ACS) and a history of cancer are high-risk. Prior studies suggest differences in acute treatment and discharge prescribing compared with non-cancer patients. METHODS:PubMed, Scopus, Embase, andClinicalTrials.gov were searched on 24 January 2025, for studies published between 2000 and 2025. Studies comparing ACS management and medication use in patients with versus without a history of malignancy were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS:Seventeen studies were included. During hospitalization, cancer patients with ACS were significantly less likely to undergo percutaneous coronary intervention (PCI), receive drugeluting stents, or receive glycoprotein IIb/IIIa inhibitors (all p < 0.001), compared to non-cancer patients. No significant differences were observed in the administration of beta-blockers (p = 0.26) or P2Y12 inhibitors (p = 0.39). At discharge, cancer patients were less likely to be prescribed dual antiplatelettherapy (p = 0.02), aspirin (p < 0.001), beta-blockers (p = 0.03), and statins (p = 0.02). No significant differences were found in prescriptions for P2Y12 inhibitors, oral anticoagulants, nitrates, calcium channel blockers, or ACE inhibitors/ARBs. CONCLUSIONS:Differences in treatment persist in both in-hospital management and discharge prescribing for cancer patients with ACS, underscoring the need for standardized, evidence-based protocols to ensure equitable care. REGISTRATION:This meta-analysis was prospectively registered with PROSPERO (CRD420251275640.).

Background: Early extubation of the ICU after coronary artery bypass graft (CABG) surgery improves recovery and the length of stay. Capnography is a noninvasive device, which is applied to identify the appropriateness of extubation, but its predictability against arterial blood gases (ABG) is unclear. Methods: This study used 70 random postoperative CABG patients to be divided into Capnography (n=35) and ABG (n=35) groups. At baseline, trigger, extubation and post-extubation, demographics, comorbidities, ventilatory, arterial blood gas and hemodynamic parameters were recorded. Between-group comparisons were done using t -tests and chi -square tests with 95% confidence intervals (CI). To determine independent predictors of early extubation, logistic regression was used. Results: Mean time to extubation was significantly shorter in the Capnography group (180 ± 40 min) versus ABG group (230 ± 60 min; mean difference −50 min, 95% CI −76 to −24; p < 0.001). Early extubation occurred in 28/35 (80.0%) patients in the Capnography group versus 22/35 (62.9%) in the ABG group (p = 0.186). Capnography patients had lower PaCO₂ at extubation (41.2 ± 5.5 mmHg vs 44.8 ± 6.1 mmHg; mean difference −3.6 mmHg, 95% CI −6.4 to −0.8; p = 0.012) and higher pH (7.38 ± 0.04 vs 7.35 ± 0.05; mean difference 0.03, 95% CI 0.01–0.05; p = 0.007). They also experienced fewer alarms (1.8 ± 1.0 vs 3.1 ± 1.4; mean difference −1.3, 95% CI −1.9 to −0.7; p < 0.001), fewer manipulations (2.2 ± 1.1 vs 3.0 ± 1.5; mean difference −0.8, 95% CI −1.4 to −0.2; p = 0.013), and shorter ICU stay (2.1 ± 0.8 vs 2.8 ± 1.1 days; mean difference −0.7, 95% CI −1.1 to −0.3; p = 0.003). Logistic regression identified Capnography group (AOR 3.06; 95% CI 1.10–8.47; p = 0.031), normal PaCO₂ (AOR 2.67; 95% CI 1.01–7.02; p = 0.047), low alarms (AOR 3.18; 95% CI 1.21–8.29; p = 0.019), and short ICU stay (AOR 4.38; 95% CI 1.52–12.65; p = 0.006) as independent predictors of early extubation. Conclusion: Capnography is more effective than ABG in predicting early extubation after CABG surgery. It reduces time to extubation, improves ventilation parameters, minimizes alarms and manipulations, and is an independent predictor of successful early extubation

Objectives The focus of the present study is to highlight and understand the effect of hysterectomy on physical, psychological, social and marital status among women aged under 40 years of age, in the cultural context of PakistanDesign The study used a qualitative phenomenological approach to explore the lived experiences of the women.Settings The present study was conducted at Sheikh Zayed Hospital, a tertiary care public sector hospital located in Lahore, Pakistan.Participants The participants of the study were women under 40 years of age who have undergone hysterectomy in the last 2 years. The data of such women were recruited from the hospital and were selected using pre-defined inclusion and exclusion criteria through purposive sampling. In-depth interviews were conducted with seven women, and data were analysed thematically.Results Four major themes and 12 sub-themes evolved during data analysis that included 1) physical and psychological effects (physical changes and recovery period, the tragedy of invisible loss of an organ and emotional distress and mood swings); 2) family and communal dynamics (reaction of in-laws, reaction of parents and siblings and reaction of friends and colleagues); 3) role fulfilment (wife and child bearer, sick role, professional role and domestic role) and 4) effects on marital life (relationship with husband and insecurity of the possibility of husband taking a second wife).Conclusion The present study found that women who have undergone hysterectomy before the age of 40 years have adverse physical, psychological, social and marital effects in their lives due to lack of societal support and acceptance related to the anatomical procedure. These findings highlight the profound influence of socio-cultural expectations and familial dynamics on women’s post-hysterectomy experiences, underscoring the need for greater awareness and sensitivity toward their physical and psychosocial well-being.